Abstract
Purpose
To investigate the incidence of scapular dyskinesis (SD) in patients with rotator cuff tears using pre- and postoperative 3D computed tomography, analyze the changes in scapular kinematics that occur after arthroscopic rotator cuff repair, and identify the contributing clinical factors.
Methods
Thirty-five patients (mean age, 62.5 ± 8.4 years) were included. Four scapular angles (upward rotation, internal rotation, protraction, and posterior tilt) were measured. The patients were categorized into three pre-existing SD types according to the difference in measured scapular angles between the affected and unaffected sides (type 1 SD, posterior tilt angle difference < − 5°; type 2 SD, internal rotation angle difference > 5°; and type 3 SD, upward rotation angle difference > 5°). The prevalence, factors influencing SD, and outcomes were compared between the improved and sustained SD groups.
Results
Twenty three of the 35 patients (65.7%) with rotator cuff tears had SD (type 1, 11; type 2, six; type 3, six). Of the 23 preoperative SD patients, 12 (52.1%) showed improved SD postoperatively. Most of the patients with improved SD (9/12) had type 1 SD (p = 0.021) and a significantly improved posterior tilt angle (p = 0.043). The improvement in SD was correlated with a higher range of motion of forward flexion and higher Constant scores (all p < 0.05). No healing failure occurred in the improved SD group (p = 0.037).
Conclusion
The prevalence of SD was high in patients with degenerative rotator cuff tears. More than half of the SD cases, especially type 1 SD, improved postoperatively. SD recovery correlated with better function and successful rotator cuff healing.
Level of evidence
IV.
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References
Barcia AM, Makovicka JL, Group MS (2021) Scapular motion in the presence of rotator cuff tears: a systematic review. J Shoulder Elbow Surg 30(7):1679–1692. https://doi.org/10.1016/j.jse.2020.12.012
Chung SW, Lee YS, Kim JY, Lee JH, Ki SY, Oh KS et al (2019) Changes in perianchor cyst formation over time after rotator cuff repair: influential factors and outcomes. Am J Sports Med 47(1):165–172. https://doi.org/10.1177/0363546518810517
Chung SW, Oh KS, Ki SY, Kim J, Yoon JP, Kim JY (2019) Factors associated with needle breakage of antegrade suture passer and effect of intratendinous remnant needle tip on clinical outcomes after arthroscopic rotator cuff repair. Acta Orthop Traumatol Turc 53(2):106–114. https://doi.org/10.1016/j.aott.2018.12.006
Corse T, Dayan L, Kersten S, Battaglia F, Terlecky SR, Han Z (2020) Clinical outcomes of COVID-19 patients with pre-existing, compromised immune systems: a review of case reports. Int J Med Sci 17(18):2974–2986. https://doi.org/10.7150/ijms.50537
Dickerson P, Pill SG, Longstaffe R, Shanley E, Thigpen CA, Kissenberth MJ (2020) Systematic review of reversing pseudoparalysis of the shoulder due to massive, irreparable rotator cuff tears. J Shoulder Elbow Surg 29(7S):S87–S91. https://doi.org/10.1016/j.jse.2020.04.039
Du-Han Kim S-SN, Baek CS, Cho CH (2020) Bilateral acromial stress fractures in a patient with a massive rotator cuff tear. Clin Shoulder Elb 23(2):105–108. https://doi.org/10.5397/cise.2020.00080
Fuchs B, Weishaupt D, Zanetti M, Hodler J, Gerber C (1999) Fatty degeneration of the muscles of the rotator cuff: assessment by computed tomography versus magnetic resonance imaging. J Shoulder Elbow Surg 8(6):599–605. https://doi.org/10.1016/s1058-2746(99)90097-6
Goutallier D, Postel JM, Bernageau J, Lavau L, Voisin MC (1994) Fatty muscle degeneration in cuff ruptures. Pre- and postoperative evaluation by CT scan. Clin Orthop Relat Res 304:78–83
Gumina S, Carbone S, Postacchini F (2009) Scapular dyskinesis and SICK scapula syndrome in patients with chronic type III acromioclavicular dislocation. Arthroscopy 25(1):40–45. https://doi.org/10.1016/j.arthro.2008.08.019
Jarvis DL, Waterman BR, Verma NN (2019) Is acromioplasty ever indicated during rotator cuff repair? Arthroscopy 35(6):1639–1640. https://doi.org/10.1016/j.arthro.2019.04.008
Kholinne E, Kwak JM, Sun Y, Kim H, Koh KH, Jeon IH (2020) Evaluation of deltoid origin status following open and arthroscopic repair of large rotator cuff tears: a propensity-matched case-control study. Clin Shoulder Elb 23(1):11–19. https://doi.org/10.5397/cise.2020.00017
Kibler WB, Sciascia A (2010) Current concepts: scapular dyskinesis. Br J Sports Med 44(5):300–305. https://doi.org/10.1136/bjsm.2009.058834
Kibler WB, Sciascia A (2019) Evaluation and management of scapular dyskinesis in overhead athletes. Curr Rev Musculoskelet Med 12(4):515–526. https://doi.org/10.1007/s12178-019-09591-1
Kibler WB, Uhl TL, Maddux JW, Brooks PV, Zeller B, McMullen J (2002) Qualitative clinical evaluation of scapular dysfunction: a reliability study. J Shoulder Elbow Surg 11(6):550–556. https://doi.org/10.1067/mse.2002.126766
Kijima T, Matsuki K, Ochiai N, Yamaguchi T, Sasaki Y, Hashimoto E et al (2015) In vivo 3-dimensional analysis of scapular and glenohumeral kinematics: comparison of symptomatic or asymptomatic shoulders with rotator cuff tears and healthy shoulders. J Shoulder Elbow Surg 24(11):1817–1826. https://doi.org/10.1016/j.jse.2015.06.003
Lefevre-Colau MM, Nguyen C, Palazzo C, Srour F, Paris G, Vuillemin V et al (2018) Kinematic patterns in normal and degenerative shoulders. Part II: Review of 3-D scapular kinematic patterns in patients with shoulder pain, and clinical implications. Ann Phys Rehabil Med 61(1):46–53. https://doi.org/10.1016/j.rehab.2017.09.002
Longo UG, Risi Ambrogioni L, Berton A, Candela V, Massaroni C, Carnevale A et al (2020) Scapular dyskinesis: from basic science to ultimate treatment. Int J Environ Res Public Health 17(8):2974. https://doi.org/10.3390/ijerph17082974
Mandalidis DG, Mc Glone BS, Quigley RF, McInerney D, O’Brien M (1999) Digital fluoroscopic assessment of the scapulohumeral rhythm. Surg Radiol Anat 21(4):241–246. https://doi.org/10.1007/BF01631393
McClure PW, Michener LA, Sennett BJ, Karduna AR (2001) Direct 3-dimensional measurement of scapular kinematics during dynamic movements in vivo. J Shoulder Elbow Surg 10(3):269–277. https://doi.org/10.1067/mse.2001.112954
Murena L, Canton G, Vulcano E, Cherubino P (2013) Scapular dyskinesis and SICK scapula syndrome following surgical treatment of type III acute acromioclavicular dislocations. Knee Surg Sports Traumatol Arthrosc 21(5):1146–1150. https://doi.org/10.1007/s00167-012-1959-9
Na Y, Zhu Y, Shi Y, Ren Y, Zhang T, Liu W et al (2019) A meta-analysis comparing tenotomy or tenodesis for lesions of the long head of the biceps tendon with concomitant reparable rotator cuff tears. J Orthop Surg Res 14(1):370. https://doi.org/10.1186/s13018-019-1429-x
Oh JH, Chung SW, Oh KS, Yoo JC, Jee W, Choi JA et al (2018) Effect of recombinant human growth hormone on rotator cuff healing after arthroscopic repair: preliminary result of a multicenter, prospective, randomized, open-label blinded end point clinical exploratory trial. J Shoulder Elbow Surg 27(5):777–785. https://doi.org/10.1016/j.jse.2017.11.019
Oh JH, Kim SH, Lee HK, Jo KH, Bin SW, Gong HS (2008) Moderate preoperative shoulder stiffness does not alter the clinical outcome of rotator cuff repair with arthroscopic release and manipulation. Arthroscopy 24(9):983–991. https://doi.org/10.1016/j.arthro.2008.06.007
Oh CH, Oh JH, Kim SH, Cho JH, Yoon JP, Kim JY (2011) Effectiveness of subacromial anti-adhesive agent injection after arthroscopic rotator cuff repair: prospective randomized comparison study. Clin Orthop Surg 3(1):55–61. https://doi.org/10.4055/cios.2011.3.1.55
Oki S, Furuhata R, Sakamoto Y, Iwabu S (2021) Distal clavicle fracture malunion associated with scapular dyskinesis treated with 3D preoperative planning. BMJ Case Rep 14(3):e240234. https://doi.org/10.1136/bcr-2020-240234
On MG, Oh JR, Jang YH, Kim DS (2019) Epidemiologic study of shoulder injuries in the PyeongChang 2018 Winter Olympic Games. Clin Orthop Surg 11(2):187–191. https://doi.org/10.4055/cios.2019.11.2.187
Panagiotopoulos AC, Crowther IM (2019) Scapular dyskinesia, the forgotten culprit of shoulder pain and how to rehabilitate. SICOT J 5:29. https://doi.org/10.1051/sicotj/2019029
Park JY, Hwang JT, Kim KM, Makkar D, Moon SG, Han KJ (2013) How to assess scapular dyskinesis precisely: 3-dimensional wing computer tomography—a new diagnostic modality. J Shoulder Elbow Surg 22(8):1084–1091. https://doi.org/10.1016/j.jse.2012.10.046
Park JY, Hwang JT, Oh KS, Kim SJ, Kim NR, Cha MJ (2014) Revisit to scapular dyskinesis: three-dimensional wing computed tomography in prone position. J Shoulder Elbow Surg 23(6):821–828. https://doi.org/10.1016/j.jse.2013.08.016
Park JY, Lhee SH, Choi JH, Park HK, Yu JW, Seo JB (2008) Comparison of the clinical outcomes of single- and double-row repairs in rotator cuff tears. Am J Sports Med 36(7):1310–1316. https://doi.org/10.1177/0363546508315039
Park JH, Oh KS, Kim TM, Kim J, Yoon JP, Kim JY et al (2018) Effect of smoking on healing failure after rotator cuff repair. Am J Sports Med 46(12):2960–2968. https://doi.org/10.1177/0363546518789691
Pepe M, Kocadal O, Gunes Z, Calisal E, Aksahin E, Aktekin CN (2018) Subacromial space volume in patients with rotator cuff tear: the effect of surgical repair. Acta Orthop Traumatol Turc 52(6):419–422. https://doi.org/10.1016/j.aott.2018.08.003
Rodosky MW, Harner CD, Fu FH (1994) The role of the long head of the biceps muscle and superior glenoid labrum in anterior stability of the shoulder. Am J Sports Med 22(1):121–130. https://doi.org/10.1177/036354659402200119
Umehara J, Yagi M, Hirono T, Komamura T, Nishishita S, Ichihashi N (2019) Relationship between scapular initial position and scapular movement during dynamic motions. PLoS ONE 14(12):e0227313. https://doi.org/10.1371/journal.pone.0227313
Warner JJ, McMahon PJ (1995) The role of the long head of the biceps brachii in superior stability of the glenohumeral joint. J Bone Joint Surg Am 77(3):366–372. https://doi.org/10.2106/00004623-199503000-00006
Warner JJ, Micheli LJ, Arslanian LE, Kennedy J, Kennedy R (1992) Scapulothoracic motion in normal shoulders and shoulders with glenohumeral instability and impingement syndrome. A study using Moire topographic analysis. Clin Orthop Relat Res 285:191–199
Yoshida M, Collin P, Josseaume T, Ladermann A, Goto H, Sugimoto K et al (2018) Post-operative rotator cuff integrity, based on Sugaya’s classification, can reflect abduction muscle strength of the shoulder. Knee Surg Sports Traumatol Arthrosc 26(1):161–168. https://doi.org/10.1007/s00167-017-4608-5
Ziegler P, Kuhle L, Stockle U, Wintermeyer E, Stollhof LE, Ihle C et al (2019) Evaluation of the Constant score: which is the method to assess the objective strength? BMC Musculoskelet Disord 20(1):403. https://doi.org/10.1186/s12891-019-2795-6
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This paper was supported by Konkuk University in 2019.
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HE Song gathered the data, wrote the initial draft of the manuscript and managed the study. KS Oh designed the study. JP Yoon analysed the data. DR Lee, S Baek conceived the study. SW Chung was involved in the study design, supervision, drafting and revision of the manuscript.
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IRB No. (KUMC2020-02-021.)
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This study was performed at Konkuk University School of Medicine.
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Song, H.E., Oh, KS., Yoon, J.P. et al. Improvement in scapular dyskinesis after rotator cuff repair and subacromial decompression. Knee Surg Sports Traumatol Arthrosc 29, 3961–3970 (2021). https://doi.org/10.1007/s00167-021-06681-x
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DOI: https://doi.org/10.1007/s00167-021-06681-x